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Medical Group Management Association

MGMA and coalition partners release new prior authorization principles

Press Release - January 25, 2017

Medicare Payment Policies

New prior authorization principles important step in reducing administrative burden, improving patient care

Englewood, Colo. – Today, a coalition of 16 provider organizations, including the Medical Group Management Association (MGMA), released a set of prior authorization principles aimed at reducing the administrative burden associated with receiving approval from a health plans, benefit managers and others to deliver care to patients. The coalition developed a set of 21 principles tackling five broad categories including clinical validity, continuity of care, transparency and fairness, timely access and administrative efficiency, and alternatives and exemptions. The goal of the coalition is to shine a bright light on today’s prior authorization requirements and offer tangible recommendations for improving the current process.

“Health plan demands for prior approval for physician-ordered medical tests, clinical procedures, medications, and medical devices ceaselessly question the judgement of physicians, resulting in less time to treat patients and needlessly driving up administrative costs for medical groups,” said Halee Fischer-Wright, MD, MMM, FAAP, CMPE, MGMA President and CEO. “Most importantly, despite the fact that the vast majority of prior authorization requests are ultimately approved, jumping through these administrative hoops can lead directly to delay or disruption in the delivery of care to the patient. Working together, the coalition has developed a landmark set of principles and I anticipate that this effort will translate directly into a reduction in the waste associated with prior authorization requirements.” 

The coalition will seek to work cooperatively with health plans and others to identify opportunities to streamline today’s cumbersome prior authorization environment. Along with MGMA, coalition members include the: American Medical Association, American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology, American Academy of Family Physicians, American College of Cardiology, American College of Rheumatology, American Hospital Association, American Pharmacists Association, American Society of Clinical Oncology, Arthritis Foundation, Colorado Medical Society, Medical Society of the State of New York, Minnesota Medical Association, North Carolina Medical Society, Ohio State Medical Association and Washington State Medical Association.

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